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If it was me, I’d probably get two opinions if you’re able to since you’re looking for a complete overhaul. IF possible. Since they’re both not too far out, and you’re not in a crisis. I’d want to be sure they seemed confident and in the same ballpark. Just ME. All of the other opinions are great too, this is just what I personally would do. Good luck. 

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12 minutes ago, DammitJanet said:

If it was me, I’d probably get two opinions if you’re able to since you’re looking for a complete overhaul. IF possible. Since they’re both not too far out, and you’re not in a crisis. I’d want to be sure they seemed confident and in the same ballpark. Just ME. All of the other opinions are great too, this is just what I personally would do. Good luck. 

thanks!

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22 minutes ago, looking for answers said:

I dunno where I want to start. The mood stabilizer for one I’m so flat. 

Im on 4 meds for sleep

welbutrin always Made me a little agitated didn’t hear but not a huge fan.

So I guess a complete overhaul!

It's good to strike a balance between stimulating and sedating. In your case though, it's mostly sedating. That's a solid dose of quetiapine (assuming you are still taking 150mg) as well as trazodone at 100mg and clonazepam at 1mg. On the other end of the spectrum 300mg of bupropion and 40mg of Vyvanse is nothing to shake your head at.

Because anxiety lends to dysphoria, it would make sense to remove something that could potentially cause you anxiety or make you feel agitated and you've clearly called out bupropion. From there you would probably want to roll back the clonazepam because long-term benzo use is definitely not ideal. Continuing on amantadine and melatonin as well as the Vyvanse makes sense to me. I'm not sure I see the point in taking both trazodone and quetiapine together though in moderate doses like that. It's kind of redundant. The only things the quetiapine does that trazodone doesn't is norepinephrine reuptake inhibition (which bupropion is also doing) and dopamine antagonism.

The lithium can also be sedating. That is something to consider, but it should be less impactful during the day if it's all taken at night.

A solid combo of lithium+quetiapine and add on the Vyvanse should be really good for depression and mood stability all on its own. You could also increase it further to get some stimulation out of it that's lost by stopping the bupropion. It just comes down to whether or not the lithium+quetiapine combo is ENOUGH for your depression. And some people can't get by without an antidepressant. I would honestly say go back to Trintellix just because it's going to have fewer side effects than some of your other previous SSRI trials like paroxetine.

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1 minute ago, browri said:

It's good to strike a balance between stimulating and sedating. In your case though, it's mostly sedating. That's a solid dose of quetiapine (assuming you are still taking 150mg) as well as trazodone at 100mg and clonazepam at 1mg. On the other end of the spectrum 300mg of bupropion and 40mg of Vyvanse is nothing to shake your head at.

Because anxiety lends to dysphoria, it would make sense to remove something that could potentially cause you anxiety or make you feel agitated and you've clearly called out bupropion. From there you would probably want to roll back the clonazepam because long-term benzo use is definitely not ideal. Continuing on amantadine and melatonin as well as the Vyvanse makes sense to me. I'm not sure I see the point in taking both trazodone and quetiapine together though in moderate doses like that. It's kind of redundant. The only things the quetiapine does that trazodone doesn't is norepinephrine reuptake inhibition (which bupropion is also doing) and dopamine antagonism.

The lithium can also be sedating. That is something to consider, but it should be less impactful during the day if it's all taken at night.

A solid combo of lithium+quetiapine and add on the Vyvanse should be really good for depression and mood stability all on its own. You could also increase it further to get some stimulation out of it that's lost by stopping the bupropion. It just comes down to whether or not the lithium+quetiapine combo is ENOUGH for your depression. And some people can't get by without an antidepressant. I would honestly say go back to Trintellix just because it's going to have fewer side effects than some of your other previous SSRI trials like paroxetine.

Yes. But apparently theres a billion interactions with this combo of meds as well. Per Neuro-Your meds have severe interactions with one another, you have to be extremely careful with what you add in or take. The combinations dont seem to make much sense...2 neuros actually

 

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Posted (edited)
37 minutes ago, looking for answers said:

thanks!

Have you tried viibryd? It’s activating like Wellbutrin, but like you, I had severe agitation with Wellbutrin where I don’t have it with viibryd...and I find it equally activating and helps with anxiety quite a lot as well. Just thought I’d throw that out there. Viibryd can cause gi issues, but I started taking iron with it and was even able to increase dose! Cause iron can bind you up, stopping diarrhea. 

Edited by DammitJanet
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3 minutes ago, DammitJanet said:

Have you tried viibryd? It’s activating like Wellbutrin, but like you, I had severe agitation with Wellbutrin where I don’t have it with viibryd...and I find it equally activating and helps with anxiety quite a lot as well. Just thought I’d throw that out there. Viibryd can cause gi issues, but I started taking iron with it and was even able to increase dose! Cause iron can bind you up, stopping diarrhea. 

I have not tried that actually one of the few I haven’t, maybe I’ll bring it up. Thank u!

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19 hours ago, looking for answers said:

Yes. But apparently theres a billion interactions with this combo of meds as well. Per Neuro-Your meds have severe interactions with one another, you have to be extremely careful with what you add in or take. The combinations dont seem to make much sense...2 neuros actually

And your neuros are probably right lol. 

19 hours ago, DammitJanet said:

Have you tried viibryd? It’s activating like Wellbutrin, but like you, I had severe agitation with Wellbutrin where I don’t have it with viibryd...and I find it equally activating and helps with anxiety quite a lot as well. Just thought I’d throw that out there. Viibryd can cause gi issues, but I started taking iron with it and was even able to increase dose! Cause iron can bind you up, stopping diarrhea. 

That's actually a brilliant idea to use iron, because other than the fact that Viibryd caused a major increase in GI motility (and consequential diarrhea), it was a great antidepressant. I wasn't on a mood stabilizer when I was taking it though, so I'm not totally sure how it would work for me now.

@looking for answers she is right that Viibryd is pretty activating and it may be a suitable substitute for the Wellbutrin while also improving anxiety rather than worsening it.

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19 minutes ago, browri said:

And your neuros are probably right lol. 

That's actually a brilliant idea to use iron, because other than the fact that Viibryd caused a major increase in GI motility (and consequential diarrhea), it was a great antidepressant. I wasn't on a mood stabilizer when I was taking it though, so I'm not totally sure how it would work for me now.

@looking for answers she is right that Viibryd is pretty activating and it may be a suitable substitute for the Wellbutrin while also improving anxiety rather than worsening it.

Wel then , that sounds great. Aside from

in on linzess

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52 minutes ago, browri said:

And your neuros are probably right lol. 

That's actually a brilliant idea to use iron, because other than the fact that Viibryd caused a major increase in GI motility (and consequential diarrhea), it was a great antidepressant. I wasn't on a mood stabilizer when I was taking it though, so I'm not totally sure how it would work for me now.

@looking for answers she is right that Viibryd is pretty activating and it may be a suitable substitute for the Wellbutrin while also improving anxiety rather than worsening it.

Thanks! I finally said something helpful! 😂 

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On 8/14/2019 at 9:10 AM, looking for answers said:

Wel then , that sounds great. Aside from

in on linzess

Oh well Linzess should be able to handle any diarrhea because if I understand linaclotide reduces gut motility. So Viibryd could be a great option for you.

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4 minutes ago, browri said:

Oh well Linzess should be able to handle any diarrhea because if I understand linaclotide reduces gut motility. So Viibryd could be a great option for you.

No it’s for constipation. Increases transit time.

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1 hour ago, looking for answers said:

No it’s for constipation. Increases transit time.

Then Viibryd is perfect for you. 😂 

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Posted (edited)
4 hours ago, looking for answers said:

No it’s for constipation. Increases transit time.

Omg the total opposite

3 hours ago, DammitJanet said:

Then Viibryd is perfect for you. 😂 

Yes it definitely would. You totally wouldn't even need Linzess anymore I would think lol

Edit: I'm actually pretty sure there were studies done on Viibryd treatment in those with depression or anxiety who also had IBS-C.

Edited by browri

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Wel we’re jumping the gun quite a bit here. 

Havent even seen new doc, diagnoses or discussed a med peel back much less med switch.

plus I was hospitalized within the past month for gi issues, linzess stays.

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On 8/15/2019 at 2:53 PM, browri said:

Omg the total opposite

Yes it definitely would. You totally wouldn't even need Linzess anymore I would think lol

Edit: I'm actually pretty sure there were studies done on Viibryd treatment in those with depression or anxiety who also had IBS-C.

What studies

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